Provider Demographics
NPI:1881398378
Name:NOVERON, MAYRA QUENNA CASTREJON
Entity type:Individual
Prefix:
First Name:MAYRA QUENNA
Middle Name:CASTREJON
Last Name:NOVERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 W COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2724
Mailing Address - Country:US
Mailing Address - Phone:714-446-0200
Mailing Address - Fax:
Practice Address - Street 1:1324 W COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-2724
Practice Address - Country:US
Practice Address - Phone:714-446-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist